Preventing injuries makes CMs invaluable
Learn how and really prove your worth
The average cost for a single workers’ compensation claim for carpal tunnel syndrome is $12,730, according to 1996 data from the National Council on Compensation Insurance in Boca Raton, FL.
Case managers have proven that they can reduce the cost of work-related injuries after the fact. But experts interviewed by Case Management Advisor argue that with the entrance of managed care into the workers’ comp arena, the time is right to go a step further and prevent work-related injuries before they occur.
"You have to wear a lot of hats as a case manager these days," explains Karen M. Bobetic, RN, COHN-S, CRRN, CCM, FSR, director of risk management for Professional Risk Management Services in Houston. "You can’t just react to an injury. Your job security depends on making yourself invaluable by preventing injuries. Knowledge is power. You can write your ticket if you know what you are doing," she says.
"The idea behind managed care is to make it unprofitable to be sick, and now that’s being applied to workers’ comp," notes Barbara Lutrell, RN, BSN, ABQQUR, CDMCS, director of workplace health services for Cerulean Workplace Health, a wholly owned subsidiary of Blue Cross/Blue Shield of Georgia in Atlanta. "That managed care approach means that workers’ comp case managers must make a paradigm shift to do prevention."
"Case managers need to develop skills necessary to go on site and recognize risk factors and then take steps to minimize those risks," agrees Bobetic. "I went out and attended every ergonomic program I could find in a three-year period. I even took a master’s-level course in ergonomics at a local school of public health. The opportunities are out there," she notes.
First: Track trends
The first step to helping an employer develop an injury prevention plan is to evaluate the employers’ medical spending and identify any trends or patterns, says Faith Perry, a workplace health consultant with Cerulean. "You have to help them understand where their medical dollars are going," she notes, adding that the same information can be used later to help prove the effectiveness of your prevention measures.
Cerulean usually collects data going back for a 12-month period but can go back as many as five years, if necessary, says Lutrell. "The smaller the work force, the further back you may have to go to be sure that your data isn’t skewed," she notes. Medical cost data Cerulean routinely analyzes for employers include:
• type of injuries;
• number of injuries;
• severity of injuries;
• department where injuries occur;
• shift on which injuries occur;
• how injuries occur;
• how long injured workers remain off the job;
• how long workers remain on light duty.
"I try to find a place to start. Is there one department that experiences more injuries than any other? Are all the repetitive injuries occurring on the same shift?" explains Perry.
The next step is to actually observe the workers on the job. "If all the injuries are occurring on the same shift, you have to watch the workers and see what they are doing that may be causing the injuries," says Perry. Things case managers should evaluate include:
• the machinery used;
• the body position of workers;
• the general health, age, and sex of workers.
"You not only have to look at the machinery and the work but take a close look at the workers, as well," says Perry. "There may be preexisitng conditions that predispose workers to injury, such as obesity. You cannot control all the possible risk factors, but by being aware of them, you can sometimes minimize them," she adds.
Case managers should also suggest wellness programs as a solution to reducing some risk for injury, note Perry and Bobetic. "Workers who are normally sedentary and/or obese run a greater risk for injury. If you expand your case management services to include workplace wellness programs that reduce the incidence of injuries, it will show up on your bottom line," adds Bobetic.
"Healthy workers are more productive," agrees Perry. "Employers haven’t really been aware of that before because they’ve never looked closely at the full cost of losing their workers. By first finding the trends in the employers’ medical costs, you can better make arguments about where those costs are and how to prevent them," she adds.
Second: Modify risk factors
Case managers can take more than one approach to preventing injuries, but engineering solutions are a logical place to start, says Perry. "Look at the machinery critically and ask yourself what you can do to make the equipment better ergonomically," she explains.
Even case managers who do not routinely develop injury prevention plans for workers’ comp clients can help prevent future injuries on an individual basis by urging physicians to request an ergonomic review of an injured employee’s work station, notes Lutrell. "Helping prevent reinjury is part of a good care plan," she adds. "The employee will not be totally healed unless the workstation is modified to prevent reinjury."
Ergonomic solutions case managers might consider depend on the equipment being used, which can vary greatly from heavy industrial settings to office settings, says Perry. Some examples include:
• Can the equipment be adjusted to each worker to create a better fit?
• Can a crane be brought in to give workers lifting capability?
• Can the equipment be raised or lowered to place worker in a better position?
Workers themselves can be a great source of practical solutions to engineering problems, notes Perry. "The case manager can basically say, Hey, I know this machine stinks, but what would you do to improve it?’"
"The problem with engineering solutions is that they may be too expensive, or maybe only one or two workers really need the change, and that makes the cost unreasonable," notes Perry. "The second area where changes can be made to reduce injuries is in administrative policies and procedures," she adds. Some examples of administrative changes that might help prevent injuries include:
• pacing workload so workers don’t have to rush to complete a difficult or risky task;
• changing work distribution so that the same risky task does not always fall to workers on one shift.
"Don’t overlook the impact of personality conflicts," adds Lutrell. "If there are two employees on one shift that don’t get along, their risk for injury rises. Can one employee be moved to a different section or department? Or is it a supervisor/employee conflict? Ask whether the employee can report to someone else," she suggests.
A final approach to preventing workers’ comp claims is providing personal protective equipment for workers in risky jobs, says Perry. "I really consider this the last resort, because it means you aren’t going to prevent the injury but simply reduce the severity of the injury when it happens," she notes.
In addition, protective equipment such as gloves, boots, and safety glasses can be uncomfortable for workers and diminish their ability to move effectively, Perry cautions.
Third: Add up the savings
Much of the savings currently being measured in case management is "soft," says Lutrell. "By doing a careful trend analysis of the employers’ medical costs first, we can go back three months later and compare the costs for the period since our intervention with the historical claims data and prove our worth," she notes.
"We can also do provider profiling," adds Lutrell. "We can show employers that a particular group of doctors routinely ordered expensive diagnostic procedures for every worker, but that because we intervened, we saved them X dollars in medical costs for unnecessary diagnostic work," she notes.
"We have a provider network. We ask our physicians to accept a price lower than the workers’ comp fee schedule and follow standard protocols," says Lutrell.
"Our physicians sign a contract that states they will work with us as a team and follow our protocols. That also helps us prove to employers that we were responsible for any reductions in workers’ comp costs they experience," she adds.
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